Presentation on theme: "Memory and its disorders Classic cases and introduction"— Presentation transcript:
1 Memory and its disorders Classic cases and introduction Chris Moulin & Céline SouchaySchool of PsychologyUniversity of Leedshttps://elgg.leeds.ac.uk/psccjam
2 Celine PhD, University of Tours, France Supervisor, Michel Isingrini Key papers:Souchay, C., Moulin, C.J.A. (in press). Memory and consciousness in Alzheimer’s disease. Current Alzheimer Research.Souchay, C. (2007). Metamemory in Alzheimer's disease. Cortex, special issue on Alzheimer's disease, 43,Souchay, C., Bacon, E., Danion, J-M. (2006). Metamemory in Schizophrenia: an exploration of the feeling-of-knowing state. Journal of Clinical and Experimental Neuropsychology, 28(5):Souchay, C., Isingrini, M., Espagnet, L. (2000). Relations between Feeling-of-knowing and Frontal lobe functioning in older adults. Neuropsychology, 14 (2),
3 Chris PhD, Bristol, UK Supervisors, Tim Perfect & Alan Baddeley Key papers:Moulin, C.J.A., Perfect, T.J., Jones, R.W. (2000). Evidence for intact memory monitoring in Alzheimer's disease: Metamemory sensitivity at encoding. Neuropsychologia, 38:Moulin, C.J.A., Conway, M.A., Thompson, R.G., James, N., Jones, R.W. (2005). Disordered Memory Awareness: Recollective Confabulation in Two Cases of Persistent Déjà vecu. Neuropsychologia, 43 :Moulin, C.J.A., Laine, M., Rinne, J.O., Kaasinen, V., Hiltunen, J., Sipilä, H. (2007). Brain function during multi-trial learning in Mild Cognitive Impairment: A PET activation study. Brain Research, 1136,Rathbone, C.J., Moulin, C.J.A., Conway, M.A. (2008). Self-centered memories: The reminiscence bump and the self. Memory and Cognition, 36(8):
4 Course OverviewLecture 1. Memory and its disorders. Classic cases in the study of memory 2h CM & CSLecture 2. An overview of models of memory function 2h CMLecture 3. Memory and the self 2h CM & CSLecture 4. Freud was right: Inhibitory processes in memory 2h CMLecture 5. Metacognition 2h CSLecture 6. Remembering and consciousness 2h CMLecture 7. Recollection and the Brain 2h CS(Private Study, 4h)Final Session. Case studies in Memory, student led discussion
5 Content & GoalsDescribe the differences in disorders of memory due to neurological and psychiatric disordersDemonstrate a sound understanding of key contemporary concepts in Memory Theory (as suggested by, but not restricted to the topics of the lecture list).Connect theoretical concepts in the literature to clinical cases and novel special populationsDescribe both how models of memory have shaped our understanding of various pathologies, and how special populations, especially single cases have informed contemporary memory theory.Offer an informed opinion as to the involvement of memory in several clinical disorders.Differentiate key areas of the literature: Long term versus short term memory, semantic versus episodic memory, explicit versus implicit memory.
6 AssessmentPrivate study will require students to search for a case study in the literature and then present it very briefly to the class detailing test performance, anecdotal information, and what the case suggests for the literature. Note that pubmed enables you to restrict document types to 'case reports', and other sources restrict all publications to case reports, and journals such as Neurocase.
7 ‘a strange kind of illness seems to blame for this gap in my life ‘a strange kind of illness seems to blame for this gap in my life! Was this illness imposed upon me by other people? The only way to find out is to do a detailed examination of all the magazines, newspapers and other published material appearing during the last 6 months. The results of an inquiry will release the causes of my ‘now-living’ – despite apparently unlikely connection between the subjects.’
8 9 Classic Cases Patient RJ – bilateral-frontal lobes Patient JB - no brain damageSharon - no brain damageMrs P – left temporalClive Waring – left temporal & frontalPatient ELD – right frontalPatient PV – left hemisphere lesionPatient HM – hippocampus & surrounding temporal lobesPatient JW – medial temporal lobeMrs P – left temporal = case 2Clive Waring – left temporal & frontal = Case 1Patient ELD – right frontal = Case 3Patient PV – left hemisphere lesion = Case 4Patient HM – hippocampus & surrounding temporal lobes = Case 7Patient JW – Korsakoff’s amnesia = Case 6Patient RJ – bilateral-frontal lobes = Case 5Sharon - no brain damage = case 8
9 Case 1Herpes Simplex Encephalitis with fitting and loss of consciousnessextensive damage to the left temporal lobe extending to the frontal lobeinitially, could not answer simple questions such as "What is a tree? Do you eat it, dress in it, or pick fruit from it?"Subsequently, became extremely depressed, crying endlessly. When his wife gave him a notebook to write down why he was crying, he wrote: 'I am completely incapable of thinking.'premorbid IQ of at least 122
10 Case 1Impaired delayed copying of figures, impaired autobiographical memory, preserved STM and implicit learningMusical abilities preserved - able to follow complex repeats in a musical scoreHe wrote over and over that he had just regained consciousness for the first time. “It’s like being dead, all the bloody time.”When his wife leaves the room, patient greets her on her return as if he hasn't seen her for years.
11 Case 262-year-old female presented complaining of not remembering unusual words or people's namesMarked atrophy to the left temporal lobeStill drove and kept up her hobbies as a country dancer and a dressmakerDeteriorated to comprehension at the level of a five-and-a-half year-old child'Is a kitten young?''what on earth is a kitten?''who wrote Hamlet?''who is Hamlet?'
12 Case 2digit span of 7preserved autobiographical memory and awareness of current affairsOver-regularises the pronunciation of words like yacht and pint. Progressively more and more familiar and frequently encountered words were affectedEventually, complained that foods did not taste the same as they used to. Misidentified objects and only used items that were familiar to her
13 Case 3 49 year-old woman, educated to A-level right hemisphere aneurysm - heamatoma subfrontally in Sylvian fissuregood recovery, but difficulty in finding her way aroundIQ normal - Normal LTM performanceCorsi span of 3/4Impaired immediate serial recall of facesGood immediate serial recall of words
14 Case 4 26 year-old woman, 11 years of schooling Stroke with transient loss of consciousnessLeft hemisphere lesionSubsequently, good autonomous functioning - set up a businessFree recall impaired - but due to an absence of recencySuperior than controls at learning a storyUnimpaired delayed recall (drawing) of a visual figureCorsi span (6), digit span (2/3)
15 Case 5 Male, professional, aged 42 Traffic accident. Unconscious for several weeks, haemorrhaging to frontal lobes"I was driving along in South Wales, coming back from the steel company in Wales where I had been on business, and had an accident in my car, I pulled out to pass a lorry and a lorry came the other way and that lorry missed me; I then went to pull back in when I passed the lorry I was overtaking and another lorry came along and he actually hit me, so there I was in the middle of the road with no car. He stopped and he said "I'm sorry mate," and I said "Don't worry about it, it was as much my fault as yours," … so we shook hands and said cheerio"
16 Case 5Were you hurt?"I went into Hereford hospital for that night … and they looked at me and they said there's nothing wrong with you, you'd better bugger off home"How did you get to the clinic then?"the sister in Hereford hospital said the best place for you to go is Rivermead … She said "You should go to Rivermead, it's the best place there is in the country for what you need … and while you're down there take so-and-so with you," which is exactly what I did.So who did you bring with you?"some girl, I can't remember her name, some big fat piece … and then I went back and took her back with me. I rang the sister of Hereford hospital and said, "I'm back now and I've brought what's-her-name back with me".
17 Case 6Male, born in Aged 53, lost job because of severe drinking problemdisorientated for time and placeWhilst living in hospital until his death he still believed himself to be living at home and working as a fitterMemory Quotient of 62 (normal = 100), recognition superior to recallA retrograde memory problem that affected memories from well before the 1970s. 2 standard deviations below normal for people famous in the 1970s, but less impaired for faces from progressively earlier periodsUnimpaired STM, but accelerated forgetting - unable to retain information for more than 30 seconds
18 Case 7 The Most famous memory patient of all time Intact implicit memory, impaired explicit memoryIntact short term memory, impaired long term memory
19 Case 834 year-old womanFound naked, unconscious and near starvation in a park, her skin covered with sores and rat-bitesCould not identify herself and could not remember how she had came to be in the parkAfter seven months of hospitalisation, she was identified by her family through a media campaign. She accepted her family as her own, but never recognised themFace recognition comparable to a control participant of the same age and IQ
20 Case 8When asked to generate personal memories to cue words, virtually none of them came from the time period before her discovery in the park, although the control participant recalled most memories from a comparable period.During hypnotherapy, recovered memories from before her admission to hospital and of the events leading up to being found in the park. She had run away with her boss and he had held her as a prisoner for virtually five years. She had escaped – to the park where she was found
21 Case 9 Patient JB 54-year-old male presented at casualty complaining of inability to remember anything of the last few daysextremely severe retrograde and anterograde amnesiahigh levels of Gamma GT in blood, an indication of alcoholismDisorientated in time, but not in spaceNo language or problem solving impairmentssignificantly below chance on a forced-choice recognition task
22 Case 9STM for lists of five digits equally poor with a filled or unfilled delay.Implicit memory functioning in the normal range,Working memory seriously impaired.Equally impaired on recall and recognitionAware of memory difficultiesDid not recall his name or address for several days, until he was identified by a friend.
24 Who is who? Mrs P Case 2 left temporal Semantic Dementia Clive Waring left temporal & frontalVery Dense AmnesicPatient ELDCase 3right frontalVisuospatial STMPatient PVCase 4left hemisphere lesionVerbal STMPatient JBCase 9no brain damageMalingererPatient HMCase 7hippocampus & surrounding temporal lobesDense AmnesicPatient JWCase 6medial temporal lobeKorsakoff’s amnesiaPatient RJCase 5bilateral-frontal lobesFrontal lobe confabulatorSharonCase 8Psychogenic Fugue
25 ReferencesClive Wearing in chapter 2 of: Campbell, R. & Conway, M. A. (1995). Broken memories: case studies in memory impairment. Oxford: Blackwell.Mrs P in chapter 16 of: Campbell, R. & Conway, M. A. (1995). Broken memories: case studies in memory impairment. Oxford: Blackwell.ELD in: Hanley, J. R., Young, A. W. & Pearson, N. A. (1991). Impairment of the visuo-spatial sketch pad. The Quarterly Journal of Experimental Psychology, 43A,JB is a composite of patients reported in chapter 15 of: Baddeley, A. D., Wilson, B. A. & Watts, F. M. (1995). Handbook of memory disorders. Chichester: John Wiley & Sons.PV in: Basso, A., Spinnler, H., Vallar, G. & Zanobio, M. E. (1982). Left hemisphere damage and selective impairment of auditory-verbal short-term memory. Neuropsychologia, 20,JW in chapter 9 of: Campbell, R. & Conway, M. A. (1995). Broken memories: case studies in memory impairment. Oxford: Blackwell.RJ in: Baddeley, A. & Wilson, B. (1986). Amnesia, autobiographical memory, and confabulation. In D. C. Rubin (Ed.), Autobiographical memory Cambridge: Cambridge University Press.Sharon in chapter 14 of: Baddeley, A. D., Wilson, B. A. & Watts, F. M. (1995). Handbook of memory disorders. Chichester: John Wiley & Sons.Patient HM: Everywhere
27 What does all that mean? Many different forms of memory dysfunction Most of which map onto brain structuresNeed for different systems and different testsMemory is not a monolithic entityEach error, each case is evidence for some system or other at work